Tyler Natasha, Wright Nicola, Grundy Andrew, Gregoriou Kyriakos, Campbell Stephen, Waring Justin
NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.
School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.
Front Psychiatry. 2020 Apr 21;11:328. doi: 10.3389/fpsyt.2020.00328. eCollection 2020.
Discharge from acute mental health services has long been associated with mortality, risk, and related adverse outcomes for patients. Many of the interventions that currently aim to reduce adverse outcomes focus on a single group of healthcare professionals within a single healthcare setting. A recent systematic review highlights very few robust interventions that specifically aim to improve communication across services. However the importance of promoting interagency working and improving information flow between services is continually highlighted as a key priority.
Using a novel codesign and experience based approach we worked with a multistakeholder group to develop possible solutions to reduce the adverse outcomes commonly associated with discharge from acute mental health services. This utilized a modified Nominal Group Technique and creative problem solving method to follow a four-stage process: Problem Identification, Solution Generation, Decision-Making, Prioritization and Implementation. Thirty-two healthcare professionals and an expert by lived experienced engaged with the process that took place over two stakeholder events.
Stakeholders at the first event identified and agreed upon 24 potential ideas to improve discharge from acute mental health services. These were refined at the second event to four elements of an interagency intervention: a multiagency 'Discharge Team' (with designated discharge coordinator), inclusive technology enabled team meetings, universal documentation and a patient generated discharge plan.
This is the first study to codesign an interagency mental health discharge intervention based around a discharge team. We developed a model for working that places a greater focus on a patient generated discharge plan, interagency working, and information flow. A pilot of the proposed intervention is now needed to test the feasibility and effectiveness in reducing adverse outcomes.
长期以来，急性精神卫生服务机构的出院环节一直与患者的死亡率、风险及相关不良后果相关联。当前许多旨在减少不良后果的干预措施都聚焦于单一医疗机构内的某一组医护人员。最近的一项系统评价表明，专门旨在改善跨机构沟通的有力干预措施非常少。然而，促进跨机构合作以及改善机构间信息流的重要性一直被视为关键优先事项而不断被强调。
我们采用一种新颖的基于共同设计和经验的方法，与一个多利益相关方团队合作，以制定可能的解决方案，以减少通常与急性精神卫生服务机构出院相关的不良后果。这利用了改良的名义小组技术和创造性问题解决方法，遵循四个阶段的过程：问题识别、解决方案生成、决策、优先级确定和实施。32名医护人员和一名有实际经验的专家参与了在两次利益相关方活动中进行的这一过程。
第一次活动中的利益相关方识别并商定了24条改善急性精神卫生服务机构出院环节的潜在想法。这些想法在第二次活动中被提炼为一项跨机构干预措施的四个要素：一个多机构“出院团队”（配有指定的出院协调员）、具备包容性技术的团队会议、通用文档以及患者生成的出院计划。
这是第一项围绕出院团队共同设计跨机构精神卫生出院干预措施的研究。我们开发了一种工作模式，更加强调患者生成的出院计划、跨机构合作和信息流。现在需要对所提议的干预措施进行试点，以测试其在减少不良后果方面的可行性和有效性。
